Sally Satel: How inhaling e-cigarettes could save your life

An electronic cigarette is displayed at a kiosk at the Lehigh Valley Mall… (Morning call File Photo )

February 17, 2014|By Sally Satel

Should electronic cigarettes be regulated like tobacco products, emblazoned with warnings and subject to tight marketing restrictions? Those are among the questions before the Food and Drug Administration as it decides in the coming weeks how to handle the battery-powered cigarette mimics that have become a $1.5 billion business in the United States.

Groups promoting intensive regulation include the American Lung Association and the Campaign for Tobacco-Free Kids. They worry that the health risks haven't been fully established and that e-cigarettes will make smoking commonplace again, especially among teens. They are quick to push back in response to anything that might make e-cigarettes more attractive, such as the NJOY King ad that aired during the Super Bowl or when actors Leonardo DiCaprio and Julia Louis-Dreyfus were shown "vaping" at the Golden Globes.

A surgeon general's report released last month, on the 50th anniversary of the office's first warning about the dangers of smoking, had little to say about e-cigarettes. Its suggestions for further reducing tobacco use were familiar, including: increase taxes on cigarettes, prohibit indoor smoking, launch media campaigns and reduce the nicotine content of cigarettes.

E-cigarettes, however, could be what we need to knock the U.S. smoking rate from a stubborn 18 percent to the government's goal of 12 percent by 2020. We should not only tolerate them but encourage their use.

Although critics stress the need for more research, we can say with high confidence that e-cigarettes are far safer than smoking. No tobacco leaves are combusted, so they don't release the tars and gases that lead to cancer and other smoking-related diseases. Instead, a heating element converts a liquid solution into an aerosol that users exhale as a white plume.

The solution comes in varying concentrations of nicotine from high (36 mg per milliliter of liquid) to zero to help people wean themselves off cigarettes, as well as e-cigarettes, and the addictive stimulant in them. But even if people continue using electronic cigarettes with some nicotine, regular exposure has generally benign effects in healthy people, and the FDA has approved the extended use of nicotine gums, patches and lozenges.

The other main ingredients in e-cigarettes are propylene glycol and glycerin. These are generally regarded as harmless they're found in toothpaste, hand sanitizer, asthma inhalers, and many other FDA-approved foods, cosmetics and pharmaceuticals. There are also traces of nitrosamines, known carcinogens, but they are present at levels comparable to the patch and at far lower concentrations than in regular cigarettes 500- to 1,400-fold lower. Cadmium, lead and nickel may be there, too, but in amounts and forms considered nontoxic.

"Few, if any, chemicals at levels detected in electronic cigarettes raise serious health concerns," a 2011study in the Journal of Health Policy determined. "A preponderance of the available evidence shows [e-cigarettes] to be much safer than tobacco cigarettes and comparable in toxicity to conventional nicotine replacement products."

The potential for e-cigarettes to help people quit smoking is encouraging. Yet so far there has been little research on their effectiveness. A study published in the Lancet in November concluded that e-cigarettes, with or without nicotine, were as effective as nicotine patches for helping smokers quit. Granted, patches have had a disappointing record in helping people stay off cigarettes for more than a few months. But there are reasons to think that e-cigarettes would be even more effective outside the laboratory.

Participants in the Lancet study were randomly assigned to nicotine e-cigarettes, patches or placebo e-cigarettes. In the real world, of course, people get to choose. And e-cigarettes have several advantages over patches and gums. For one, they provide a quicker fix, because the pulmonary route is the fastest practical way to deliver nicotine to the brain. They also offer visual, tactile and gestural similiarities to traditional cigarettes.

Reporter Megan McArdle tested the comparison for a Bloomberg Businessweek article this month: "After I'd put it together, I had something surprisingly close to one of the cigarettes I used to smoke. The mentholated tobacco flavor rolled sinuously over my tongue, hit the back of my throat in an unctuously familiar cloud, and rushed through my capillaries, buzzing along my dormant nicotine receptors. The only thing missing was the unpleasant clawing feeling in my chest as my lungs begged me not to pollute them with tar and soot."